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460 Franklin 2016 from 10/23 - 12/06 TerminationRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from (� A - / f!.O through/) 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 4 fficeholder, Candidate Controlled Committee ElPrimarily Formed Ballot Measure J State Candidate Election Committee Committee O Recall O Controlled (Also Complete Pert 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee • Sponsored ❑ Primarily Formed Candidate/ • Small Contributor Committee Officeholder Committee • Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMIMA TTEE) 0 HSS .5io6, x) �,oc-s-roo CITYJ STPffft ZIP CODE AREACUDEtPHUNL r4 MAJ LING ADDRESS (IF DIFFERENT) NO. AND STREET ORP 0. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/ E-MAILADDRESS 4. Verification ``� I have used all reasonable diligence in preparing and reviewing this statement and to the bUtf�certify under penalty of perjury under the laws of the State of California that the foregoing i Executed on ®1 v 0,-3 —)" I By Darle Executed on — _ 3 d BY Date Signature of Coni Date of election if appli (Month, Day, Year) RECEIVED JAN 5 2017 CITY OF LA QUINTA Y CLERK DEPARTME I 2. Type of Statement: ❑ Preelection Statement ❑ emi-annual Statement Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OFURER ., .7- MAI UNG ADDRES S AY&S C 0+� CITY ,n..�J STA NAME OF ASS TANT TREASURER, IF ANY ltAL5 MAILING ADDRESS S3i�Lro CITY ,�ryyST COVER PAGE ` of For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ZIP CODE AREA CODE/PHONE 7;45L-6-3 940-911-1001D JD the information contained herein and in the attached schedules is true and complete. I I% - Executed Executed on BY Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on BY - Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee NAME OF pF CEHOLDER OR CANDJDATE -N , rnJ DFF E SOLTGkTOR HELD (INCLUDE LOC ON AND DISTRICT NUMIB'ER IF RESIDENTIAUBUSIN SSADDRESS (N A D STREET) CITY "91,obv r I NGS 0 /v 1 N STATE ZIP Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page --�'— of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEAS N BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT A/ ❑ OPPOSE NAME OF OF ICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period . from �� f SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through Page of r NAME OF FILER I.D. NUMBER Contributions Received Column A TOTAL THIS PERIOD Column IS Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ $ /1 —iJ 1/1 through 6/30 7/1 to Date 2. Loans Received ............................................................. ... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 20. Contributions 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 "� 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ $ Made $ $ Expenditures Madef�5a Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E, Line 4 $ $ Candidates "{ 7. Loans Made....................................................................... Schedule H, Line 3 �. ig5 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS....... ................................... Add Lines 6+7 $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 Date of Election Total to Date 10. Nonmonetary Adjustment.......................................................:.Schedule C, Line 3- (mm/dd/yy) -;kcl' 67� 11. TOTAL EXPENDITURES MADE........................................Add Lines 8+9+10 $ $ ��i $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 13. Cash Receipts...................................................,,,,.... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE .................Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts. ...... ........ ............. Add Line 2 +Line 9 in Column B above $ 5�- To calculate Column B, add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from t®" ,13 . 1 —-/HEDULE E SEE INSTRUCTIONS ON REVERSE through 11 f r0 Page il of _ NAME OF FILER I.D. NUMBER k_15rq IF4A)4LIrd /_-3 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID 04-rit_,l�Csr�a i 2/ 6�-c-rir� PPoy�[�5 1�Y, 3... k a. _ o pr'o �io a> C �4- ` Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)................................................................................... 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ i g S.;t C-7" FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov